老年胸腔镜术后发生静脉血栓栓塞症患者临床特征及预后分析

目的 探究胸腔镜术后发生静脉血栓栓塞症(VTE)患者的临床特征及危险因素。方法 回顾性分析2014年1月至2020年8月于北京协和医院行胸腔镜手术患者的临床资料,收集VTE与非VTE患者的人口学特征、手术相关信息与住院时间,针对年龄、体质量指数(BMI)及手术时长手术因素分析30d VTE累计发生率。采用SPSS 28.0软件进行数据分析。根据数据类型,组间比较分别采用U检验、χ²检验及Fisher确切概率检验。结果 共纳入腔镜手术患者21227例,包括胸腔镜手术患者2133例,腹腔镜手术患者17213例。腹腔镜患者术后VTE发生率为0.43%(74/17213)。胸腔镜患者术后VTE的发病率为1.22%(26/2133),其中术后深静脉血栓形成(DVT)占34.62%(9/26),肺血栓栓塞症(PTE)占65.38%(17/26);与非VTE患者比较,发生VTE患者年龄更高[65(60,73)和54(43,62)岁,P<0.001],BMI更大[25.46(24.61,28.67)和23.83(21.51,26.03)kg/m²,P<0.001],恶性肿瘤发生率更高[22(84.62%)和1203(57.10%),P=0.005]、手术时间[165(119,214)和95(67,134)min,P<0.001]及住院时间[10(8,18)和6(4,7)d,P<0.001]更长;将胸腔镜手术患者分为<60岁、60~<65岁、65~<70岁、≥70岁组,术后VTE发病率分别为0.43%(6/1391)、1.75%(6/342)、2.12%(5/236)、5.49%(9/164);胸腔镜手术患者年龄≥65岁(OR=2.917,95%CI 1.253~6.788;P=0.013),BMI>25kg/m²(OR=2.484,95%CI 1.089~5.667,P=0.031),手术时间≥120min(OR=4.683,95%CI 1.762~12.241,P=0.002)是胸腔镜术后VTE的独立危险因素。与年龄＜65岁、BMI≤25kg/m²、手术时间<120min的患者相比,年龄≥65岁[9/164(5.49%)和17/1969(0.86%),P<0.001]、BMI>25kg/m²[15/757(1.98%)和11/1376(0.80%),P=0.012]、手术时间≥120min[2.86%(20/699)和0.42%(6/1434),P<0.001]的患者胸腔镜术后30d内VTE发病率更高。结论 北京协和医院胸腔镜术后VTE发病风险高于腹腔镜手术,VTE发病率随患者年龄上升而上升,年龄≥65岁、BMI>25kg/m²及手术时长≥120min是胸腔镜术后VTE的独立危险因素。     

北京协和医院内科老年住院患者静脉血栓栓塞症流行病学调查

目的调查北京协和医院内科老年住院患者静脉血栓栓塞症(VTE)流行病学数据,分析老年患者VTE临床特征。方法回顾性分析2016年5月至2016年9月北京协和医院内科住院患者3115例,根据年龄分为老年组(≥65岁,771例)和非老年组(65岁,2344例)。收集患者基线信息、出院后随访3个月症状性VTE的发生及VTE预防情况,比较2组发生VTE的相关危险因素差异。采用SPSS 23.0软件进行统计学处理。根据数据类型,2组间比较采用t检验或χ~2检验,多组间比较采用单因素方差分析。患者发生VTE的危险因素分析采用logistic回归法。结果内科患者症状性VTE总发病率为2.50%(78/3115),老年组与非老年组患者VTE发病率分别为3.11%(24/771)和2.30%(54/2344),差异无统计学意义(P=0.249)。≥40岁的患者VTE发病率随年龄增加呈增长趋势,但各年龄段间比较差异无统计学意义。ICU老年VTE发病率最高(42.86%,3/7),且显著高于其他各科室(P0.05)。与非老年组比较,老年组高血压、基于Padua模型的高风险、活动性恶性肿瘤/化疗、糖尿病、冠心病、心脏和(或)呼吸衰竭、急性心肌梗死和(或)缺血性卒中比例显著增加,使用糖皮质激素治疗、炎症性肠病及血栓形成倾向比例显著降低,差异有统计学意义(P0.01)。多因素logistic回归分析显示,既往VTE史(OR=63.316,95%CI 19.355~207.127)及使用雌、孕激素(OR=133.278,95%CI 9.660~1838.773)是内科老年患者发生VTE的独立危险因素(P0.001)。有48.72%(38/78)的内科VTE患者及54.17%(13/24)的老年VTE患者在发病前未接受抗凝药物或机械预防。结论北京协和医院内科住院患者VTE发病率随增龄呈增长趋势,应注意增加对老年患者尤其有既往VTE史和使用雌、孕激素患者的VTE事件预防。     

老年变应性鼻炎的临床特征及危险因素

目的 研究老年变应性鼻炎(AR)的临床特征及危险因素。方法 将2018年1月至2022年12月北京王府中西医结合医院诊治的236例AR患者纳为研究组,根据患者年龄,将其分为中青年组(年龄18~59岁,102例)及老年组(年龄≥60岁,134例);同时将医院同期接收的160例与老年组AR患者性别、年龄相似,但无变应性临床症状的老年志愿者作为对照组。首先比较中青年组及老年组AR患者的临床特征,再以对照组为参照,通过二元logistic回归模型分析影响老年AR发病的相关因素。采用SPSS 19.0软件进行数据分析。组间比较采用χ²检验。结果 不同年龄段AR患者性别比例及发病高峰期比较,差异均无统计学意义;老年AR患者变应原检出阳性率为32.09%(43/134),低于中青年组的68.63%(70/102),差异有统计学意义(P<0.05)。老年组患者AR分型多为间歇性(53.73%,72/134),严重程度多为轻度(63.43%,85/134);中青年组患者AR分型多为持续性(60.78%,62/102),轻度和中-重度严重程度各占50.00(51/102),差异有统计学意义(P<0.05)。老年AR患者伴随症状咽喉不适/咳嗽发生率为29.85%(40/134),低于中青年组的46.08%(47/102),差异有统计学意义(P<0.05);其余伴随症状比较,差异无统计学意义。二元logistic回归分析提示,饲养宠物、职业接触粉尘、AR家族史以及哮喘史是影响老年AR发病的独立危险因素(OR=1.752、2.036、1.992、3.916;P<0.05)。结论 与中青年相比,老年AR患者变应原阳性率更低、临床表现及病情严重程度更轻,临床应注重老年AR的筛查及诊断,减少漏诊误诊率;此外,还应注重具有饲养宠物、职业性接触粉尘、AR家族史及哮喘史等AR危险因素且具备临床症状的老年人的AR筛查。     

老年下肢静脉曲张患者的临床特点分析

目的 分析老年下肢静脉曲张患者的临床特点,为老年人群疾病的诊疗管理提供依据。方法 回顾性分析2015年1月至2020年12月于西安交通大学第一附属医院住院手术的3860例下肢静脉曲张患者的临床资料,根据年龄将患者分为老年组(≥60岁,n=1540)与非老年组(＜60岁,n=2320),收集2组患者的临床资料。采用SPSS 18.0统计软件进行数据分析,根据数据类型分别使用t检验、χ²检验或Mann-Whitney U检验进行组间比较。结果 2组患者CEAP分级情况比较,差异有统计学意义(P<0.05),老年组患者以C4期为主,非老年组患者以C3期为主。老年组患者患病时间多于非老年组;全身或局部合并症多于非老年组;住院时长多于非老年组;下地活动时间晚于非老年组,差异均有统计学意义(P＜0.05)。结论 老年组患者患病时间长,疾病严重程度重,且多合并其他系统性疾病及局部并发症,因此需全面评估并进行个体化治疗。     

老年药物洗脱支架再狭窄及影响因素分析性

目的 调查冠心病经皮冠状动脉介入治疗(PCI)患者药物洗脱支架再狭窄(DES-ISR)现状及相关因素。方法 将2018年6月至2021年6月陆军军医大学第二附属医院收治的536例行PCI手术治疗的冠心病患者纳为研究对象,根据患者行PCI手术时的年龄,将其分为老年组(n=330)及青中年组(n=206)。术后随访6~12个月,统计不同年龄段PCI手术患者DES-ISR发生率,根据造影结果将患者分为ISR组及非ISR组,分别分析影响不同年龄段冠心病PCI手术患者DES-ISR的相关因素。采用SPSS 20.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。结果 老年及中青年PCI患者术后DES-ISR发生率分别为18.18%(60/330)与15.53%(32/206),差异无统计学意义。老年PCI术后ISR组中合并糖尿病、合并分叉、钙化病变及弥漫狭窄病变、术后服药依从性差、支架断裂、支架扩张不足、术前Gensini评分、支架直径、支架长度、支架个数以及空腹血糖水平高于非ISR组,差异均有统计学意义(均P<0.05)。中青年PCI术后ISR组中合并高血压、吸烟、饮酒者占比高于非ISR组,Gensini评分及低密度脂蛋白胆固醇水平均高于非ISR组,差异均有统计学意义(均P<0.05)。结论 影响不同年龄段CHD患者PCI术后DES-ISR发生率的相关因素不尽相同,老年PCI术后DES-ISR发生风险主要与其冠状动脉病变严重程度及支架植入状况相关,而中青年PCI术后DES-ISR发生风险则主要与其术后不良生活习惯相关。     

高龄腹部大手术患者术中低体温影响因素及其预防管理

目的 调查高龄腹部大手术患者术中低体温发生率,分析影响术中低体温的相关因素。方法 将2022年1月至2023年1月在中国人民解放军联勤保障部队第九六四医院收治的146例行腹部大手术的高龄患者纳为研究对象。统计其术中低体温发生率及术中低体温对患者术后并发症的影响,采用logistic回归模型分析影响高龄腹部大手术患者术中低体温的相关影响因素。采用SPSS 22.0统计软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。结果 146例高龄腹部大手术患者中,发生术中低体温患者共76例(52.05%),发生术中低体温患者麻醉恢复期寒颤、代谢性酸中毒、电解质紊乱等发生率均高于正常体温组,差异均有统计学意义(P<0.05)。二元logistic回归分析发现,体质量指数≥24kg/m²(OR=0.212, 95%CI 0.073~0.615)及输液加温(OR=0.459, 95%CI 0.279~0.756)是高龄腹部大手术患者术中低体温发生的保护因素,而麻醉时间≥3h(OR=2.010, 95%CI 1.604~2.518)、术中输液量＞2000ml(OR=1.912,95%CI 1.164~3.139)是其危险因素。结论 高龄腹部大手术患者术中低体温发生率较高,术中低体温会增加患者术后各种并发症发生率;建议采用复合措施,以降低患者术中低体温发生率。     

老年病人髋关节置换术后静脉血栓栓塞预测模型的建立与分析

目的通过分析老年病人髋关节置换术后静脉血栓栓塞症(VTE)发生的危险因素,建立列线图评价模型,并评价模型预测术后VTE的准确性。方法选择2017年1月至2019年1月期间,四川省骨科医院收治的老年髋关节置换术病人144例为研究对象,其中发生术后VTE的病人24例作为VTE组,另外120例无VTE的病人为对照组。采用单因素、多因素Logistic回归模型,分析老年病人髋关节置换术后VTE的危险因素。根据回归分析结果,建立列线图评价模型。利用ROC曲线及Hosmer-Lemeshow检验评价模型的预测效能。结果多因素分析显示,年龄、血糖、应用骨水泥是发生术后VTE的危险因素,应用预防血栓药物、按计划进行主被动训练是发生术后VTE的保护因素(P0.05)。根据多因素分析结果,成功建立列线图预测模型。Hosmer-Lemeshow检验结果显示,模型的预测效能为95.83%,模型拟合良好。ROC曲线显示,列线图模型预测老年病人髋关节置换术后VTE的AUC为0.988,特异性为96.77%,敏感性为99.82%。结论基于年龄、血糖、是否应用骨水泥、术后是否应用预防血栓药物治疗、术后是否按计划进行主被动训练建立的预测老年病人髋关节置换术后VTE发生风险的列线图模型,具有良好的特异性和敏感性,临床价值较高。     

下肢静脉曲张术后静脉血栓栓塞症风险因素分析及药物预防

目的:筛选术后静脉血栓栓塞症(VTE)发生的高危因素以及并验证抗凝治疗方法的有效性。方法:纳入2 196例患者,按预防策略不同分为两组,A:非抗凝组(n=542),B:抗凝组(n=1 554)。A组根据是否发生VTE分为两组:A1:发生VTE组(n=28),A2:未发生VTE组(n=514)。对患者的年龄,性别,手术部位,BMI,CEAP分级,Kistner分级,麻醉方法,手术时程以及是否合并血栓性浅静脉炎(STP)等资料以及实验室检查数据进行多因素分析找出导致差异的因素。结果:D-二聚体测定值在A1组与A两组,差异有统计学意义(P0.001),而A1组中血栓性浅静脉炎STP的发生率(20/28,71.4%)明显大于A两组(191/514,37.2%)(P0.001);CEAP分型中A1组C4及以上分级明显高于A两组(C4:15/28 vs. 188/514,C5∶7/28 vs. 86/514,C6∶6/28 vs. 53/514),(P0.05)。将筛出的差异有统计学意义的因素,进行多因素Logistic回归分析结果显示:合并STP和CEAP分级中C4级以上是静脉曲张术后VTE发生的危险因素。结论:合并STP是静脉曲张术后VTE发生的高危因素,抗凝可以有效预防此类患者术后VTE的发生。结合前期研究,我们推荐对合并STP并接受高位结扎剥脱术的静脉曲张患者采用低分子肝素0.6 mL qd皮下注射的方式预防术后VTE的发生。     

脑梗死合并代谢综合征的老年人群发病特点及其危险因素分析

目的 分析脑梗死合并代谢综合征老年人群发病特点及危险因素。方法 收集2015年3月至2019年10月于江苏省扬州友好医院就诊的临床诊断为脑梗死的老年患者154例,其中合并代谢综合征患者80例(观察组),单纯脑梗死患者74例(对照组),对2组患者一般临床资料、血浆胆固醇(TC)、甘油三酯(TG)及高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、收缩压、舒张压、餐后2h血糖、空腹胰岛素、神经功能和并发症发生情况进行比较,并对脑梗死合并代谢综合征相关因素进行多因素logistic回归分析。采用SPSS 21.0软件进行数据分析。根据数据类型,组间比较分别采用χ²检验或者t检验。结果 观察组患者BMI(28.3±3.5)kg/m²、腰围(94.6±10.2)cm、吸烟史[35例(43.8%)]、饮酒史[33例(41.3%)]、高血压[57例(71.3%)]、高血糖[64例(80.0%)]和高血脂[49例(61.3%)]均高于对照组[25.7±2.9)kg/m²、(89.3±9.4)cm、20例(27.0%)、18例(24.3%)、36例(48.6%)、39例(52.7%)、30例(40.5%)],差异均有统计学意义(均P<0.05)。观察组患者TC(5.25±1.13)mmol/L、TG(2.36±0.85)mmol/L、FPG(7.83±0.87)mmol/L、收缩压(149.32±12.41)mmHg (1mmHg=0.133kPa)、舒张压(89.34±9.12)mmHg、餐后2h血糖(10.81±3.45)mmol/L和空腹胰岛素(10.86±2.75)mmol/L均高于对照组[(4.89±0.94)mmol/L、(1.82±0.64)mmol/L、(6.28±0.57)mmol/L、(141.71±11.52)mmHg、(82.31±7.61)mmHg、(7.87±3.14)mmol/L和(8.49±2.53)mmol/L],观察组HDL-C(0.94±0.24)mmol/L低于对照组(1.08±0.36)mmol/L,差异均有统计学意义(均P<0.05)。观察组患者神经功能评分(24.62±6.74)分、神经功能评分等级为重型的比例41.3%(33/80)、肺部感染11.3%(9/80)、心力衰竭28.8%(23/80)、肝肾衰竭的发生率16.3%(13/80),均高于对照组[(17.21±6.25)分、21.6%(16/74)、2.7%(2/74)、9.5%(7/74)、4.1%(3/74)],差异均有统计学意义(均P<0.05);观察组与对照组脑梗死的复发率比较,差异无统计学意义(P>0.05)。通过logistic回归分析发现高血压、FPG≥6.1mmol/L、TG≥1.7mmol/L、肺部感染及肥胖均为脑梗死合并代谢综合征的危险因素。结论 脑梗死合并代谢综合征的老年患者的病情重,预后差,且高血压、FPG≥6.1mmol/L、TG≥1.7mmol/L、肺部感染及肥胖为脑梗死合并代谢综合征老年患者的危险因素。     

老年人心房颤动导管射频消融并发心脏压塞的临床分析

目的探讨年龄与房颤导管消融并发心脏压塞之间的关系。方法回顾性收集2013年1月至2016年12月在北京安贞医院行首次房颤导管射频消融术的患者,收集其围术期临床资料,分为老年组(≥60岁)和非老年组(<60岁),利用回归模型分析老年与房颤消融心脏压塞发生的关系。结果本研究共纳入患者5313例,发生心脏压塞41例(0.77%);老年组心脏压塞发生比例1.1%(32/2950),明显高于非老年组0.4%(9/2363)(χ²=8.489,P=0.004)。老年组1例行急诊开胸心房修补术,而非老年组0例;无1例患者院内死亡。多因素Logistic回归分析结果显示,与非老年组患者比较,老年组发生心脏压塞发生风险增加(OR=2.570,95%CI:1.190~5.570,P=0.017);分层分析结果显示,女性、口服抗凝药物、左房内径<40 mm和手术时间≥120 min的患者中,老年组心脏压塞发生风险较非老年组更高(OR=1.011、2.914、3.922、3.244,均P<0.05)。结论老年(年龄≥60岁)是房颤导管消融发生心脏压塞的独立危险因素。     

Regenerative therapies in electrophysiology and pacing

The prevention and treatment of cardiac arrhythmias conferring major morbidity and mortality is far from optimal, and relies heavily on devices and drugs for the partial successes that have been seen. The greatest success has been in the use of electronic pacemakers to drive the hearts of patients having high degree heart block. Recent years have seen the beginnings of attempts to use novel approaches available through gene and cell therapies to treat both brady- and tachyarrhythmias. By far the most successful approaches to date have been seen in the development of biological pacemakers. However, the far more difficult problems posed by atrial fibrillation and ventricular tachycardia are now being addressed. In the following pages we review the approaches now in progress as well as the specific methodologic demands that must be met if these therapies are to be successful.     

Advancement in antithrombotics for stroke prevention in atrial fibrillation

The focus of this review is the evolving field of antithrombotic drug therapy for stroke prevention in patients with atrial fibrillation (AF). The current standard of therapy includes warfarin, acenocoumarol and phenprocoumon which have proven efficacy by reducing stroke by 68% against placebo. However, a narrow therapeutic index, wide variation in metabolism, and numerous food and drug interactions have limited their clinical application to only 50% of the indicated population. Newer agents such as direct thrombin inhibitors, factor Xa inhibitors, factor IX inhibitors, tissue factor inhibitors and a novel vitamin K antagonist are being developed to overcome the limitations of current agents. The direct thrombin inhibitor dabigatran is farthest along in development. Further clinical trial testing, and eventual incorporation into clinical practice will depend on safety, efficacy and cost. Development of a novel vitamin K antagonist with better INR control will challenge the newer mechanistic agents in their quest to replace the existing vitamin K antagonists. Till then, the large unfilled gap to replace conventional agents remains open. This review will assess all these agents, and compare their mechanism of action, stage of development and pharmacologic profile.     

Current scenario of diabetes in India

India, a country experiencing rapid socioeconomic progress and urbanization, carries a considerable share of the global diabetes burden. Studies in different parts of India have demonstrated an escalating prevalence of diabetes not only in urban populations, but also in rural populations as a result of the urbanization of lifestyle parameters. The prevalence of prediabetes is also high. Recent studies have shown a rapid conversion of impaired glucose tolerance to diabetes in the southern states of India, where the prevalence of diabetes among adults has reached approximately 20% in urban populations and approximately 10% in rural populations. Because of the considerable disparity in the availability and affordability of diabetes care, as well as low awareness of the disease, the glycemic outcome in treated patients is far from ideal. Lower age at onset and a lack of good glycemic control are likely to increase the occurrence of vascular complications. The economic burden of treating diabetes and its complications is considerable. It is appropriate that the Indian Government has initiated a national program for the management and prevention of diabetes and related metabolic disorders. Lifestyle modification is an effective tool for the primary prevention of diabetes in Asian Indians. The primary prevention of diabetes is urgently needed in India to curb the rising burden of diabetes.     

Frailty and disability in the elderly: A diagnostic dilemma

Decreased reserves in multiple organ systems identify frailty syndrome in the elderly. However, its clinical diagnostic approach may be hard, particularly in patients with chronic diseases. The purpose of the study was to delineate the role of disability in the frailty syndrome in a group of hospitalized elderly people. A total of 150 consecutive patients (62 males/88 females), aged between 64 and 97 years and 1-2 days before hospital discharge, were submitted to several geriatric scales designed to assess disability and/or morbidity. All the geriatric scales used showed an elevated percentage of abnormal values both in females and in males. Nevertheless, the activities of daily living (ADL), instrumental activities of daily living (IADL), Tinetti balance index (TBI), Barthel index (BI) scores showed significantly better values in men than in women (p = 0.007, =0.02, =0.02 and =0.01, respectively). This preliminary cross-sectional study, underlines the fact that all geriatric tests employed have shown pathological scores, but those of the ADL, IADL, TBI and BI scores exploring disability were significantly better in males than in females. The mismatch between functional and morbidity tests seems to support the hypothesis that a disability state may be independent from morbidity.     

Relaxation kinetics of formoterol and salmeterol in the guinea pig trachea in vitro

The mechanisms producing long duration of action for formoterol and salmeterol are not fully understood. The aim of the current study was to examine how the concentration of long and short acting ₂-adrenoceptor agonists affects their relaxation kinetics in airway smooth muscle. Onset (time to peak relaxation) and offset of action (reassertion of reversible relaxation following repeated -adrenoceptor blockade and washout) were measured in the guinea pig trachea precontracted postjunctionally by carbachol 0.3 M in vitro. At 10–1,000% (C _1O–C _1,000) of the maximally effective concentration (C ₁₀₀: 150 nM formoterol, 10 M salbutamol, 30 M salmeterol), salbutamol had a shorter time to peak relaxation than did salmeterol. Formoterol and salmeterol had a similar time to peak relaxation at C ₁₀, but, in contrast to salmeterol, formoterol's time to peak relaxation became markedly shorter and similar to that of salbutamol as the concentration was increased up to C _1,000. Significant reversible reasserted relaxation was demonstrated for salmeterol alone at C ₁₀. At C ₃₀–C _1,000, however, salmeterol produced irreversible relaxation only, in spite of repeated -adrenoceptor blockade by sotalol 10 M followed by washout. In contrast, formoterol produced an increasing reversible reasserted relaxation at C ₃₀–C _1,000. Salbutamol produced significant, reversible reasserted relaxation at C _1,000 only. In conclusion, the concentration determines the onset and offset of action for formoterol and to a lesser extent for salbutamol, but not for salmeterol. To cause sustained action, a submaximally effective concentration is sufficient for salmeterol, whereas formoterol requires a maximally effective concentration. The rank order of concentration dependence for the relaxation kinetics is not paralleled by the rank order of lipophilicity for formoterol, salbutamol, and salmeterol. Therefore, factors other than lipophilicity may also play a role in determining the relationship between concentration and relaxation kinetics for the investigated ₂-agonists. Offprint requests to: Anders Linden, MD, PhD     

贮存式自体输血开展对优化妇科手术用血结构的影响

目的:总结本院2011-2013年贮存式自体输血开展前后,妇科手术用血异体少白细胞红细胞和自身贮血的应用情况。方法:对本院妇科手术台次,异体少白细胞红细胞及贮存式自体血液的使用人数、量及比例分别进行统计。结果:最近3年妇科手术台次逐年上升,异体少白细胞红细胞用量从463.5U下降至320.5U,自体输血量上升至161U。异体输血比例由手术人次的33.61%下降至19.80%,自体输血比例由0上升至22.61%。人均异体少白细胞红细胞使用量由0.783U下降至0.450U,人均自体全血用量由0上升至0.226U。结论:贮存式自体输血开展,使妇科手术用血结构得到优化,其对临床节约用血的影响,得到了规模性,量化体现。     

先天性唇裂功能性修复术的临床应用(附36例报告)

为重建先天性唇裂患者的口轮匝肌功能，减少术后畸形，对36例唇裂患者于唇裂修复术中将裂隙两侧迷走的口轮匝肌剥离、切断、复位，于前唇皮肤下方对位缝合(功能性修复术)。结果全部病例刀口均I期愈合，口轮匝肌运动时上唇各部分协调一致，上唇及鼻外形满意。认为功能性修复术可获得满意的外形及功能效果。     

Factors associated with long hospital stay in geriatric wards in Japan

Background:   To reduce the length of stay (LOS) in hospital, the factors associated with extended LOS have to be identified.
Methods:     A comprehensive geriatric assessment (CGA) of patients in a geriatric ward was carried out to identify the factors associated with LOS of more than 28 days.
Results:     Of 193 patients (> 65 years old) who had been admitted to the geriatric ward of Nagoya University Hospital from home, 118 patients had complete CGA data sets. The CGA items were studied within 1 week of admission and analysis was performed by Chi-squared followed by multilogistic analysis. Chi-squared analysis demonstrated that many of the basic activities of daily living (BADL) and instrumental ADL (IADL) had a significant association with longer LOS, but the contribution of psychological factors, assessed by mini-mental state examination and Geriatric Depression Scale-15, was relatively small. Multilogistic analysis showed that dependence on dressing assistance and medication assistance significantly increased the chance of having a LOS longer than 28 days.
Conclusion:     Intervention to improve the ability to dress and take medication independently may reduce LOS.